• Seby John, Syed Irteza Hussain, Mohammed Samy Elhammady, Ramon Navarro, and Khalil Zahra.
• Neurology, Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates; Neurointerventional Surgery, Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates. Electronic address: johns5@clevelandclinicabudhabi.ae.
• World Neurosurg. 2020 Aug 1; 140: 224-228.

BackgroundWe present a rare case of multiple intracranial arteriovenous fistulas (AVFs). A young female presented with headache and a left eyelid pulsatile swelling.Case DescriptionMagnetic resonance imaging demonstrated numerous dilated cortical veins, along with a prominent left superior ophthalmic vein. A diagnostic cerebral angiogram revealed 5 distinct AVFs including 4 dural AVFs (dAVFs) and a pial AVF (pAVF). The largest dAVF was at the superior sagittal sinus. The others included bilateral ethmoidal, torcular, and a pAVF arising of the right pericallosal artery. She was treated by endovascular transarterial Onyx embolization. Only the superior sagittal sinus fistula was treated via middle meningeal artery feeders with complete occlusion. Immediate follow-up angiogram also showed complete spontaneous occlusion of the untreated dAVFs and pial AVF.ConclusionsThis case is exceedingly unique considering the multiplicity of AVFs, concurrent presence of pial and dural AVF, and spontaneous occlusion of all untreated AVFs after embolizing the largest shunting fistula.Copyright © 2020 Elsevier Inc. All rights reserved.

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